Long Term Care and Alternative Housing Options

(Medicare.gov) Before you make any decisions about long term care, get as much information as you can about where you might live and what help you may need. A nursing home may not be your only choice. Discharge planners and social workers in hospitals, nursing homes, and home health agencies can explain your options and help arrange your care.

Note: If you have limited income and resources, there may be state programs that help cover some of your costs in some of these long-term care choices mentioned here. Call yourState Medical Assistance Office.

Community Services

There are a variety of community services that might help you with your personal care and activities. Some services, like volunteer groups that help with things like shopping or transportation, may be low cost or the group may ask for a voluntary donation. Some services may be available at varied costs depending on where you live and the services you need. Below is a list of home services and programs that are found in many communities:

Adult day care

Meal programs (like Meals-on-Wheels)

Senior centers

Friendly visitor programs

Help with shopping and transportation

Help with legal questions, bill paying, or other financial matters

Home Care

Depending on your needs, you may be able to get help with your personal activities (like laundry, shopping, cooking, and cleaning) at home from family members, friends, or volunteer groups.

If you think you need home care, talk to your family to see if they can help with your care or help arrange for other care providers. There are also some home health care agencies that can help with nursing or attendant care in your home.

Accessory Dwelling Units (ADUs)

If you or a loved one owns a single-family home, adding an accessory dwelling unit (ADU) to an existing home may help you keep your independence. An ADU, sometimes called an “in-law apartment,” an “accessory apartment,” or a “second unit,” is a second living space within a home or on a lot. It has a separate living and sleeping area, a place to cook, and a bathroom.

Space like an upper floor, basement, attic, or space over a garage may be turned into an ADU. Family members might be interested in living in an ADU in your home, or, you may want to build a separate living space at your family member’s home.

Check with your local zoning office to be sure ADUs are allowed in your area, and if there are special rules. The cost for an ADU can vary widely depending on how big it is and how much it costs for building materials and workers.

Subsidized Senior Housing

There are federal and state programs that help pay for housing for some older people with low to moderate incomes. Some of these housing programs also offer help with meals and other activities like housekeeping, shopping, and doing the laundry. Residents usually live in their own apartments in the complex. Rent payments are usually a percentage of your income (a sliding scale).

Board and Care Homes

Board and care homes are group living arrangements designed to meet the needs of people who can’t live independently but don’t need nursing home services. Most board and care homes provide help with some of the activities of daily living like bathing, dressing, and using the bathroom.

Board and care homes are sometimes called “group homes.” Many of these homes aren’t paid for by Medicare or Medicaid. The monthly charge is usually a percentage of your income (a sliding scale) that covers the cost of rent, meals, and other basic shared services.

Assisted Living Facilities

These facilities provide help with activities of daily living like bathing, dressing, and using the bathroom. They may also help with care most people do themselves like taking medicine or using eye drops and additional services like getting to appointments or preparing meals.

Residents often live in their own room or apartment within a building or group of buildings and have some or all of their meals together. Social and recreational activities are usually provided. Some of these facilities have health services on site.

In most cases, assisted living residents pay a regular monthly rent, and then pay additional fees for the services they get. The term “assisted living” may mean different things in different facilities. Not all assisted living facilities provide the same services. It’s important that you contact the facility and make sure they can meet your needs.

Continuing Care Retirement Communities (CCRCs)

CCRCs are retirement communities that offer more than one kind of housing and different levels of care. In the same community, there may be individual homes or apartments for residents who still live on their own, an assisted living facility for people who need some help with daily care, and a nursing home for those who require more care.

Residents move from one level to another based on their needs, but usually stay within the CCRC. If you’re considering a CCRC, be sure to check the nursing home at the CCRC. The nursing home’s quality information is on Nursing Home Compare and the nursing home’s inspection report should be posted in the nursing home.

Your CCRC contract usually requires you to use the CCRC’s nursing home if you need nursing home care. Some CCRC’s will only admit people into their nursing home if they have previously lived in another section of the retirement community, like their assisted living or an independent area.

Many CCRCs generally require a large payment before you move in (called an entry fee) and charge monthly fees.

Find out if a CCRC is accredited and get advice on selecting this type of community from the Commission on Accreditation of Rehabilitation Facilities and theContinuing Care Accreditation Commission (CARF-CCAC) by calling 1-202-587-5001.

Hospice Care

Hospice is a special way of caring for people who are terminally ill (with six months or less to live), and for their families. Hospice care includes physical care and counseling. The goal of hospice is to provide comfort for terminally ill patients and their families, not to cure illness.

If you qualify for hospice care, you can get medical and support services, including nursing care, medical social services, doctor services, counseling, homemaker services, and other types of services. As part of hospice care, you will have a team of doctors, nurses, home health aides, social workers, counselors and trained volunteers to help you and your family cope with your illness. Depending on your condition, you may get hospice care in a hospice facility, hospital, or nursing home.

Respite Care

Some nursing homes and hospice care facilities may provide respite care. Respite care is a very short inpatient stay given to a hospice patient so that the usual caregiver can rest. Medicare covers respite care for up to 5 days if you’re getting covered hospice care. Room and board are covered for inpatient respite care and during short-term hospital stays.

Program for All-Inclusive Care for the Elderly (PACE)

PACE manages all of the medical, social, and long-term care services for frail people to remain in their homes and to maintain their quality of life. PACE is available only in states that have chosen to offer it under Medicaid. The goal of PACE is to help people stay independent and living in their community as long as possible, while getting the high quality care they need. To be eligible for PACE, you must be 55 or older, live in the service area of a PACE program, be certified as eligible for nursing home care by the appropriate State agency, and be able to live safely in the community.

Home and Community-based Waiver Programs

If you’re already eligible for Medicaid, (or, in some states, would be eligible for Medicaid coverage in a nursing home) you may be able to get help with the costs of some home and community-based services, like homemaker services, personal care, and respite care. States have home and community-based waiver programs to help people keep their independence, while getting the care they need outside of an inpatient facility.